PCT 联合 CD64指数在肝硬化合并自发性细菌性腹膜炎患者抗感染治疗效果中预测作用

摘要

目的：研究降钙素原（PCT）联合 CD64平均荧光强度指数（CD64指数）在肝硬化合并自发性细菌性腹膜炎（SBP）患者抗感染治疗效果中的预测作用。方法选择2010年5月至2014年5月接受诊治的失代偿期的肝硬化腹水患者112例实施研究。依据患者临床表现及实验室检测结果将患者划分为非 SBP 组24例（阴性对照组）和疑似 SBP组70例，以及 SBP 确诊组18例。将疑似 SBP 组70例患者进一步划分亚组，分别是伴腹痛组30例，无腹痛组40例。外周血的中性粒细胞百分比上升组36例，外周血的中性粒细胞百分比未上升组34例。SBP 确诊组及疑似 SBP 组共88例经抗感染治疗后划分亚组，分别是治疗有效组59例和治疗无效组29例。对比各组实验室指标情况、疑似 SBP 组不同亚组的实验室指标情况、SBP 确诊组及疑似 SBP 组经抗感染治疗后不同效果亚组的实验室指标情况，分析 PCT 联合 CD64指数对患者治疗效果的预测作用。结果 SBP 确诊组、疑似 SBP 组及阳性对照组的腹水 CD64指数及外周血 PCT 水平均分别显著高于阴性对照组，同时，SBP 确诊组的腹水 CD64指数及外周血 PCT 水平均分别显著高于疑似 SBP 组，差异均有统计学意义（均 P ﹤0.05）。疑似 SBP 组下的伴腹痛组与无腹痛组在腹水 CD64指数、WBC 计数以及外周血 WBC和 PCT 指标水平上对比，差异无显著性。但外周血的中性粒细胞百分比上升组的腹水 CD64指数及外周血 PCT 水平均分别显著高于外周血的中性粒细胞百分比未上升组，差异均有统计学意义（均 P ﹤0.05）。治疗有效组的腹水 CD64指数及外周血 PCT 水平均分别显著低于治疗无效组，差异均有统计学意义（均 P ﹤0.05）。PCT 联合 CD64指数对患者治疗效果进行预测的灵敏度和准确性均高于两指标单独应用，特异度亦较好。结论 PCT 联合 CD64指数对肝硬化合并SBP 患者的抗感染疗效具有较好的预测作用，值得在临床上推广应用。%Objective To study prediction function of anti infection treatment effect of PCT combined with CD64 index in patients with cir-rhosis combined with spontaneous bacterial peritonitis(SBP). Methods Between May 2010 to 2014,decompensated liver cirrhosis of 112 cases of ascites were included into the present implementation research. Based on the results of clinical manifestations and laboratory results,patients were di-vided into non SBP group 24 cases(control group)and 70 cases of suspected SBP group,and SBP group 18 cases diagnosed. The suspected SBP group of 70 patients was further divided sub group,respectively with abdominal pain group 30 cases,abdominal pain in 40 cases of group. Compared with the peripheral blood neutrophil percentage of group 36 cases,the peripheral blood neutrophil percentage did not increase in the group of 34 ca-ses. The diagnosis of SBP group and SBP group were 88 cases of suspected by anti infection treatment after the division of sub groups,respectively. The treatment was effective in the treatment group of 59 cases ,and the treatment of 29 cases was ineffective in other group. Groups were compared in laboratory index,index of laboratory conditions. For different subgroups of suspected SBP group,SBP group and SBP group were diagnosed by anti infection treatment effect after different subgroups of laboratory index,analysis of effect of PCT combined with CD64 index to predict the therapeutic effects. Results SBP diagnosis group,suspected ascitic CD64 index and PCT level in the peripheral blood of SBP group and positive control group were significantly higher than that of the negative control group. At the same time,the CD64 index of ascites and peripheral blood PCT level of SBP group was significantly higher than that diagnosed were suspected of SBP group. The differences were statistically significant(all P ﹤0. 05). The as-cites CD64 index,WBC and the number of peripheral blood WBC and PCT index level were compared between the suspected with abdominal pain group of the SBP group. The difference was not significant. But ascites CD64 index and peripheral blood PCT level in peripheral blood neutrophil per-centage rise group were significantly higher than that of peripheral blood neutrophil percentage did not rise group,the difference was statistically sig-nificant( P ﹤0. 05). Ascites CD64 index and the peripheral blood levels of PCT treatment group were significantly lower than that of the ineffective treatment group,the difference was statistically significant( P ﹤0. 05). PCT and CD64 index on the therapeutic effect of patients with predictive sensitivity and accuracy were the highest,the specificity was good. Conclusion PCT combined with CD64 index in cirrhotic patients has the forecast function. The larger SBP anti infection effect in patients with obvious effect,worth in clinical application.